| NPI | 1871739540 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RANDALL R GOODE General Dentist 586-725-5500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 2901012324) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 2901019573) |
| Enumeration Date | 2008-12-30 |
| Last Update Date | 2008-12-30 |